Elizabeth Briand
Pharmacists are among the most accessible health care providers, working with patients outside of traditional clinical environments and in highly visible and trafficked settings. As such, they are uniquely positioned to provide assistance to individuals who may be experiencing abuse or violence.
“It’s important to understand state regulations, and pharmacists are interested in guidance on this,” said Marie Barnard, PhD, assistant professor of pharmacy administration at the University of Mississippi, who led a 2020 study published in the Nov/Dec issue of JAPhA on this topic. Barnard and fellow researchers examined the reporting requirements for pharmacists in all 50 states and two territories with regard to intimate partner violence, child abuse, and elder abuse. They also looked at statutes to determine if pharmacists were considered mandatory reporters for each type of abuse.
Examining the requirements
Results showed that pharmacists are specifically named as mandatory reporters of intimate partner violence in 10 states and territories, of child abuse in 12, and of elder abuse in 20, according to Barnard’s research paper in JAPhA.
In conducting the research, Barnard and colleagues used three key resources to identify existing laws: the Futures Without Violence compendium, funded by HHS; the mandatory reporting laws for child abuse published by HHS’ Children’s Bureau; and a policy database maintained by the Rape, Abuse & Incest National Network. Statutes identified were then further studied to determine specific requirements and who were designated as mandatory reporters of abuse.
Many states use the broad term “health care provider” to indicate a mandatory reporter while others require that anyone—health care provider or not—who is aware of or suspects abuse must report it. The number of states or territories in which pharmacists would be expected to report abuse stands at 31 for intimate partner violence, 45 for child abuse, and 47 for elder abuse.
Barnard has long been interested in issues of domestic violence and, as part of her dissertation prior to this study, surveyed pharmacists across the country to ask if cases of abuse had ever been disclosed to them. “Almost all of them said they had, but they had never received training on what to do,” said Barnard. “Every other health care discipline is required to have training, but pharmacists are left out of that.”
This is a significant missed opportunity, according to Barnard. Because many pharmacists work in settings such as supermarkets, they are easily accessible and can be visited by victims without undue attention from their abuser. This was especially true during the pandemic, when many people stopped going to their physician’s offices but could still see their pharmacist.
“Every other health care provider requires appointments but not pharmacists,” said Barnard. “You can just talk to your pharmacist. For individuals experiencing abuse, this is a really positive thing. But pharmacists have not been at the table for this. Patients see their pharmacists more often than their physicians, and we’re not leveraging that relationship.”
How more pharmacists can help
To be a better ally and serve as a resource for victims of abuse, pharmacists can take the initiative to learn about and stay abreast of their state’s reporting requirements. Clear corporate policies on how best to meet state guidelines also would benefit pharmacists, providing a well-defined plan of action should difficult situations arise.
Pharmacists can directly help by preparing in advance and practicing the CARD method: Care, Assess for Safety, Refer patients to local resources, and Document as appropriate for the practice setting. It includes learning what local referral services are available for victims of abuse and how to reach them; learning what mechanisms are required for reporting; preparing to hear disclosures safely and in private; and prominently displaying screening and education materials, including the National Domestic Violence Hotline (1-800-799-SAFE [7233]), which offers free and confidential help to victims in a multitude of languages 24 hours a day. ■